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Lung Ultrasound (in the Critically Ill) Superior to CT: the Example of Lung Sliding

kjccm-2016-00955f1A recent article by Daniel A. Lichtenstein published in the Korean Journal of Critical Care Medicine (Korean J Crit Care Med 2017; 32(1): 1-8.) on comparing the use of ultrasound (US) for assessment and diagnosis of pneumothorax and whether it is superior to computerized tomography (CT).

Lung Ultrasound (in the Critically Ill) Superior to CT: the Example of Lung Sliding

Help Your Team Stop Overcommitting by Empowering Them to Say No


A great article by Diana Kander on Harvard Business Review on empowering your team to say no!

There’s nothing wrong with wanting to please. In fact, we’re hardwired for it. But when we overcommit ourselves, we spend our time checking things off a list rather than actually creating value.

This problem has ramped up in recent years as likability has become a key determinant in landing jobs and other professional opportunities. But here’s the trouble with having a corporate culture built around likability: When people are afraid to turn down noncritical projects, good ideas get smothered. Without the ability to say “no” to low-level tasks in order to say “yes” to groundbreaking ones, people stop innovating.

Every company is in a value race. Not only do you have to create value for your customers, but you also have to do it before someone else does. Doing so requires the ability to say “yes” to truly great ideas — and, more importantly, to say “no” to all those good ideas that just aren’t good enough.

Here’s how to cultivate that mindset in your organization:

1. Establish a value assessment system.

2. Pay attention to warning signs.

3. Celebrate saying “no.”

4. Reward initiative.

Help Your Team Stop Overcommitting by Empowering Them to Say No


Great article on Harvard Business Review – Conflict-of-Interest Rules Holding Back Medical Breakthroughs..


A colleague of mine recently posted a link to this article, but I also thought it was a pertinent read. I actually couldn’t agree more. Health departments need to collaborate with industry and clinician experts to improve health outcomes and patient safety. Time to get out of the silos and listen to experts that don’t always work within healthcare departments.

“The big public health problems that humanity faces today — including Alzheimer’s disease, cancer, and metabolic and infectious disease — will not be solved by either sector working in a silo. But the interface between the two has never been more tense. Legitimate concerns over conflict of interest that have resulted in overly extreme preventative policies are a central cause. It is time for all parties to revisit those policies and replace them with rules that recognize both true conflicts and true confluences of interest. They are essential to forging the strong collaborations that are worthy of society’s trust.”

Conflict-of-Interest Rules Are Holding Back Medical Breakthroughs

Why vascular access leadership skills are important in the workplace

leaderI just read a great article on leadership by Stephanie C. from the UK. She states that quality leadership skills are often sought after by many employers; they not only show that you have good interpersonal skills, they also show that you have the ability to co-ordinate, motivate and shape a team. She raises 3 points on what makes leadership skills important in the workplace – points that ring true in our specialty field of practice –

  • Initiative: Often good leadership skills make you more likely to have a good sense of initiative. This means you don’t wait for other’s to tell you to perform tasks or actions. You are forward-thinking and as a result more prepared to deliver solutions to problems that arise.
  • Innovativeness: Leadership skills improve your ability to find new ways of doing things in an organisation. You are driven by the ability to change or re-invent common practices, all of which can serve to benefit an organisation.
  • Pro-activeness: Leadership skills improve your ability to be proactive. Leaders do not just ‘plan to do’, they actually ‘do’. The ‘do-ers’ are the ones whom are identified as being the most reliable and productive. If you are able to successfully execute written plans into practice, you are showing that you are able to take control of situations rather than just responding to them.

I often hear many vascular access clinicians say they want to change clinical practices within their institutions and facilities. I applaud their desire to make change for the better; for themselves, professionally; for their patients, to provide better care, and for their institution, to improve efficiencies, reduce complications and improve patient safety; however many of them are either frustrated or overwhelmed at the prospect of approaching senior administrators and high level clinicians who may be potential barriers to growth.

It is not with out the 3 elements that Stephanie describes above that change can be implemented. Things that need to be put in place to make these changes are some the following traits that leaders require to help them in their journey to facilitate change.

  • Strategic Thinking: Do you think strategically? In this case, what this means is that you often plan effectively for the forthcoming future based on a range of objectives which you set for yourself or your team. Strategic-thinkers are visionary, creative and willing to take risks. They are focussed on the long-term goals and implications of meeting them.
  • Decision-making: You can easily choose between one or two courses of action at least 70% of the time. You are able to make firm and prompt decisions with ease despite all of the options available also shows you have exceptional problem-solving skills.  A good decision-maker bases their decisions through a good balance of emotional and logical reasoning; this means considering the facts as well as the way in which a decision will effect others.
  • Time-management: This skill goes hand in hand with being organised. Do you find it easy to keep to a schedule which you set out for yourself. Are you able to prioritise effectively with tasks and deadlines. This is even more important when you are in the position of leading a team as you will need to effectively map out timelines for others.
  • Charismatic: Are you considered to be confident, assertive and/or charming? Leaders possess a certain strength of character and a strong sense of individualism. Charisma is a natural characteristic that makes it easy to influence others. Public speaking skills directly develop your level of charisma and ability to be listened to.
  • Listening: Contrary to popular belief, leaders are not always bossy. In fact they are supposed to know when to listen and when to direct. Being able to listen to suggestions and ideas effectively will help a leader implement the correct plans according to their team strengths, weaknesses, concerns and capabilities.

Vascular access specialists have an important role to fulfil within healthcare as others do – however, they also crossover and service nearly all clinical specialties within the healthcare environment as vascular access is the most performed invasive procedure globally. If your a clinician who wants to lead change within your team or facility, develop these elements, grab the evidence, inject it into your passion to improve things, and strive forward, recruiting those who will assist you in the process. It is a tough challenge, but in the end the benefits will be much greater for all.

Air Embolism – understanding WHY it occurs and HOW to prevent it

Air EmbolismAir Embolism (AE) is often a life-threatening complication of large bore intravascular device insertion and removal. Although much focus has been with the insertion phase, device removal is just as potentially dangerous.

There is becoming an increased awareness of AE through patient advocacy groups and from a patient safety perspective taught by experienced healthcare clinicians. There are more frequent publications related to AE and certainly this complication is getting a wider girth of awareness.

Essentially, ANY intravascular device – intravenous (IV) or intra-arterial (IA), can cause an AE. Although IA is potentially a lesser risk, it does not mean that it doesn’t occur.

Devices, particularly IV, should be removed with the patient satisfying the following criteria;

  1. The patient/client should be in a supine (flat) or slight Trendelenburg position (15-20° head-down) – particularly for CVADs and PICCs.
  2. Should be removed at end-expiration – for all devices.
  3. Should have an air-occlusive, paraffin or petroleum-based dressing over the removal site for 48 hours, until the exit site wound has sealed closed.

Many clinicians who remove these types of devices MUST be educated and aware of potential for AE to occur, and need to ensure that preventative measures are in place BEFORE a device is removed.

Following the three actions listed above will reduce the risk of AE in most situations.
An easy to remember way is to think, ‘the patient should be in the same position for removal of the device as for the insertion of the device’. Easy.

When air embolism is suspected, the patient should be placed on 100% oxygen and on the left lateral decubitus position, which may improve right ventricular outflow by keeping air in the right atrium or in the apex of the right ventricle, away from the pulmonary artery and right ventricular outflow tract.

AE should also be included during ‘mock’ codes – simulated scenarios for training purposes. This is one way of ensuring the education is met on a regular (or even mandatory) level within healthcare facilities for clinicians who are associated with intravascular device removal.

Here are several links to recent articles on air embolism prevention (courtesy of JVA);

Tunneled central venous catheter exchange: techniques to improve prevention of air embolism

Over-catheter tract suture to prevent bleeding and air embolism after tunnelled catheter removal

Cerebral air embolism after central dialysis line removal: the role of the fibrin sheath as portal (mechanism) of air entry

#vascularaccess #FOAMva